2027 ICD-10-CM Diagnosis Code F19.20Other psychoactive substance dependence, uncomplicated
ICD-10-CM Codes›F01–F99›F10-F19›F19
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 137
- Chronic Condition
F19.20 is a billable ICD-10-CM diagnosis code for other psychoactive substance dependence, uncomplicated. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 894 through 897. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 11 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified substance-related disorders.
For Medicare Advantage risk adjustment, F19.20 maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
F19.20 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Absinthe addiction
- Addiction
- Alcohol dependence
- Antidepressant dependence
- Combined opioid with non-opioid substance dependence
- Combined opioid with non-opioid substance dependence, continuous
- Combined opioid with non-opioid substance dependence, episodic
- Combined substance dependence, continuous
- Combined substance dependence, excluding opioid, continuous
- Combined substance dependence, excluding opioid, episodic
- Combined substance dependence, excluding opioids
- Continuous opioid dependence
- Drug addict
- Episodic opioid dependence
- Episodic polysubstance dependence
- Ergotamine dependence
- Maternal drug exposure
- Never injecting drug user
- PCP dependence
- Phencyclidine use disorder
- Physical addiction
- Physiological dependence on substance in therapeutic use
- Polysubstance dependence
- Postpartum substance dependence
- Pregnancy and substance dependence
- Psychoactive substance dependence
- Selective serotonin re-uptake inhibitor dependence
- Skin lesion in drug addict
- Substance dependence
- Substance dependence during pregnancy, childbirth and/or puerperium
- Substance dependence in childbirth
- Substance dependence in mother complicating pregnancy, childbirth and/or puerperium
- Substance dependence, continuous
- Substance dependence, episodic
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F19.20: its own notes plus those printed at F19.2, F19, and Chapter 5. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- polysubstance drug use (indiscriminate drug use)
- disorders of psychological development
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Other (or unknown) substance use disorder, moderate
- Other (or unknown) substance use disorder, severe
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name F19.20, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F19.20: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming F19.20: its condition is not part of those codes, and both may be reported when the patient has both.
- F44.0 Dissociative amnesiaalcohol-or other psychoactive substance-induced amnestic disorder (F10, F13, F19 with .26, .96) names F19, which includes this code
- T40 Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens]drug dependence and related mental and behavioral disorders due to psychoactive substance use (F10.-F19.-) names F19.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Addiction See Also: Dependence; F19.20
Dependence (on) (syndrome) F19.20
combinations of drugs F19.20
drug NEC F19.20
psychoactive NEC F19.20
nitrous oxide F19.20
polysubstance F19.20
Disorder (of) See Also: Disease;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Drug Use and Addiction
Drugs are chemical substances that can change how your body and mind work. They include prescription medicines, over-the-counter medicines, alcohol, tobacco, and illegal drugs.
The full article covers:
- What are drugs?
- What is drug use?
- What is drug addiction?
- Does everyone who takes drugs become addicted?
- Who is at risk for drug addiction?
- What are the signs that someone has a drug problem?
- What are the treatments for drug addiction?
- Can drug use and addiction be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert F19.20 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About F19.20Overview
What is the ICD-10 code for other psychoactive substance dependence, uncomplicated?
The ICD-10-CM code for other psychoactive substance dependence, uncomplicated is F19.20 (sometimes written as F1920). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F19.20 (Other psychoactive substance dependence) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other psychoactive substance dependence, uncomplicated on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F19.20 group to?
When other psychoactive substance dependence, uncomplicated is the principal diagnosis on an inpatient stay, it groups to MS-DRG 894, 897, 895, 896, with relative weights from 0.6272 to 1.6610 depending on complications. Higher weights mean higher Medicare reimbursement.
Is F19.20 a CC or MCC?
CMS lists F19.20 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 11 closely related codes in its exclusion list.
Can F19.20 be reported with a code from F19.1?
Not as a rule. The Excludes1 note at F19.2, which applies to F19.20, lists "other psychoactive substance abuse (F19.1-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is F19.20?
F19.20 (other psychoactive substance dependence, uncomplicated) maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), commonly written as HCC 137, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 55 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does F19.20 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F19.20 adds a risk adjustment factor of about 0.424 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.297 to 0.502 depending on the payment segment). A more severe related category (HCC 135 and HCC 136) supersedes it when both are reported. See the full factor table on the HCC 137 category page.
